• Journal of Preventive Medicine and Public Health
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• v.51 no.2
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• pp.71-82
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• 2018

Objectives: Areca nut is widely consumed in many parts of the world, especially in South and Southeast Asia, where cardiovascular disease (CVD) is also a huge burden. Among the forms of CVD, acute coronary syndrome (ACS) is a major cause of mortality and morbidity. Research has shown areca nut chewing to be associated with diabetes, hypertension, oropharyngeal and esophageal cancers, and CVD, but little is known about mortality and re-hospitalization secondary to ACS among areca nut users and non-users. Methods: A prospective cohort was studied to quantify the effect of areca nut chewing on patients with newly diagnosed ACS by categorizing the study population into exposed and non-exposed groups according to baseline chewing status. Cox proportional hazards models were used to examine the associations of areca nut chewing with the risk of re-hospitalization and 30-day mortality secondary to ACS. Results: Of the 384 ACS patients, 49.5% (n=190) were areca users. During 1-month of follow-up, 20.3% (n=78) deaths and 25.1% (n=96) re-hospitalizations occurred. A higher risk of re-hospitalization was found (adjusted hazard ratio [aHR], 2.05; 95% confidence interval [CI], 1.29 to 3.27; p=0.002) in areca users than in non-users. Moreover, patients with severe disease were at a significantly higher risk of 30-day mortality (aHR, 2.77; 95% CI, 1.67 to 4.59; p<0.001) and re-hospitalization (aHR, 2.72; 95% CI, 1.73 to 4.26; p<0.001). Conclusions: The 30-day re-hospitalization rate among ACS patients was found to be significantly higher in areca users and individuals with severe disease. These findings suggest that screening for a history of areca nut chewing may help to identify patients at a high risk for re-hospitalization due to secondary events.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.11
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• pp.4813-4818
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• 2016

Objective: The objective of the study was to determine the Knowledge, Attitude and Practice of chewing gutka,areca nut, snuff and tobacco smoking among the young population in the Northern India Population between the age of 15 to 22 years. Methods: The study was approved by the ethical committee. A total of 10 school and colleges located in the rural and urban areas was selected. A total of 1500 young individuals aged between 15 to 22 years were selected. A self-administered questionnaire was designed comprised of 14 closed ended questions about Knowledge, Attitude and Practice towards consumption of areca nut, gutka and tobacco smoking that were filled by the participants. Descriptive statistics were obtained and mean, standard deviation, frequency and percentages were calculated. Data was analyzed by using SPSS. Result: A total of 1050 out of 1500 students responded to the questionnaire. A total of 227 subjects agreed that they are consuming the tobacco. Out of this, 196 (86.34%) were boys and 31 (13.65%) were girls who agreed in consumption of tobacco product. Out of 196, 150 boys (76.5%) practices the habit of smoking 1 -5 times a day and 46 (23.4% ) practice the habit of chewing areca nut and gutkha 1 - 5 times a day. Out of 31 girls, 25 girls (80.6%) practices the habit of smoking 1 -5 times a day and 6 (19.4%) practice the habit of chewing areca nut and gutkha 1 - 5 times a day. Out of 740 subjects, 530 were boys and 210 girls have full knowledge of deleterious long term effects of tobacco consumption. Conclusion:The present study concluded that young population of North India lack Knowledge, Attitude and Practice regarding consumption of areca nut, gutka and tobacco smoking. Here is an urgent need to take effective steps, especially on launching community awareness programs for the school children and public to educate them about the consequences of tobacco use, and on assessing their effectiveness in curbing the problem.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.7
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• pp.3335-3340
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• 2016

Background: Oral submucous fibrosis (OSF) is a precancerous condition with a 4 to13% malignant transformation rate. Related to the habit of areca nut chewing it is mainly prevalent in South-east Asian countries where the habit of betel quid chewing is frequently practised. On chewing, alkaloids and polyphenols are released which undergo nitrosation and give rise to N-nitrosamines which are cytotoxic agents. CYP450 is a microsomal enzyme group which metabolizes various endogenous and exogenous chemicals including those released by areca nut chewing. CYP1A1 plays a central role in metabolic activation of these xenobiotics, whereas CYP2E1 metabolizes nitrosamines and tannins. Polymorphisms in genes that code for these enzymes may alter their expression or function and may therefore affect an individuals susceptibility regarding OSF and oral cancer. The present study was therefore undertaken to investigate the association of polymorphisms in CYP1A1 m2 and CYP2E1 (RsaI/PstI) sites with risk of OSF among areca nut chewers in the Northern India population. A total of 95 histopathologically confirmed cases of OSF with history of areca nut chewing not less than 1 year and 80, age and sex matched controls without any clinical signs and symptoms of OSF with areca nut chewing habit not less than 1 year were enrolled. DNA was extracted from peripheral blood samples and polymorphisms were analyzed by PCR-RFLP method. Gene polymorphism of CYP1A1 at NcoI site was observed to be significantly higher (p = 0.016) in cases of OSF when compared to controls. Association of CYP1A1 gene polymorphism at NcoI site and the risk of OSF (Odd's Ratio = 2.275) was also observed to be significant. However, no such association was observed for the CYP2E1 gene polymorphism (Odd's Ratio = 0.815). Our results suggest that the CYP1A1 gene polymorphism at the NcoI site confers an increased risk for OSF.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.16
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• pp.7007-7009
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• 2015

Background: Tobacco use in various forms, including with Areca nut, causes several potentially malignant disorders. Many lesions may transform into oral squamous cell carcinoma. Although patients may be aware of the hazards of tobacco habits, the lesions by themselves are insidious in nature resulting in failure of patients to present to general dentists/specialists at early stages. Our aim was to study the types of habits prevalent in the region of Rourkela in Orissa and to assess the insidious nature of the lesions associated with these habits. Not many studies have been done from this part of India. Materials and Methods: A camp was conducted for habitual users of tobacco and its products, Areca nut and other mixed habit users. A thorough history was taken of the type, duration and frequency of habits, symptoms of patients along with clinical examination by a single examiner. The data was entered in detail into an excel sheet and analysed. Results: 54.7% had lesions and 60.9 % of them were asymptomatic and rest had mild burning sensation while eating. There was a very low awareness of the presence of lesions among the patients. Conclusions: There is a need to spread the awareness of the ill effects of the tobacco and other associated habits far and wide and more importantly educate the general public on the appearance of associated lesions as these are almost always insidious in nature. The patients can self-examine, detect lesions early when present and approach the dentist at the earliest opportunity.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.9
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• pp.4341-4346
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• 2012

Purpose: The aim of this study was to cast light on initiating molecular events associated with the development of premalignant oral lesions induced by tobacco and/or areca nut. Method: Immunohistochemical analyses of cell cycle regulatory proteins (LIMD1, RBSP3, p16, RB, phosphorylated RB, p53), EGFR and SH3GL2 (EGFR associated protein) were performed with inflammatory/ulcerative epithelium and adjacent hyperplastic/mild dysplastic lesions. Results: No change in expression of the proteins was seen in inflammatory epithelium. Reduced nuclear expression of LIMD1 was evident in ulcerative epithelium. In hyperplastic lesions, reduced expression of RBSP3, p16, SH3GL2 and overexpression of p-RB and EGFR were apparent. Reduced nuclear expression of p53 was observed in mild dysplastic lesions. Conclusion: Our data suggest that inactivation of LIMD1 in ulcerative epithelium might predispose the tissues to alterations of other cell cycle regulatory and EGFR signaling proteins needed for the development of premalignant oral lesions.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.4
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• pp.1633-1637
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• 2012

Introduction: The incidence of oral premalignant and malignant lesions is on the rise due to an increased number of people taking in tobacco and alcohol related habits. Material and Methods: 1028 patients with tobacco, alcohol and areca nut habits attending our Department of Oral Medicine and Radiology formed the study sample. An interviewer based questionnaire was used to record the habit details. All the patients were then examined clinically for the presence of lesions. Chi square and Fisher exact tests were used to assess the statistical significance of the study parameters. Results: Males had a higher prevalence and comprised 87.9% of the sample. The commonest habit in this study sample was smoking (39.2%) followed by smokeless tobacco use (28.1%). Out of the 1028 patients with habits 40% had no clinically detectable changes in their mucosa. Of the mucosal changes leukoplakia (14%) was the commonest. Conclusions: This study provided information about the habit trends in the patients visiting this institution. The study may serve as a useful tool in educating the patients about the deleterious effects of oral tobacco, alcohol and betel exposure.

• Journal of Microbiology and Biotechnology
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• v.26 no.10
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• pp.1817-1823
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• 2016

Areca nut (AN) chewing is a habit in many countries in Central, Southern, and Southeast Asia. It is strongly associated with the occurrence of oral, pharyngeal, and esophageal cancer as well as systemic inflammation. However, the association between AN intake and the development of gastric lesions has not yet been identified. The aim of this study was to investigate the effect of AN on gastric diseases using a mouse model for Helicobacter pylori infection. We studied four groups of mice: those fed a normal diet (ND), those fed a diet containing 2.5% AN (AD), those fed ND and infected with H. pylori PMSS1 strain (ND/HP), and those fed AD and infected with H. pylori PMSS1 strain (AD/HP). Food intake and body weight were monitored weekly during the experiments. At 10 weeks, the mice were sacrificed, and the stomach weight, H. pylori colonization, and gastric inflammation were evaluated. The stomach weight had increased significantly in the ND/HP and AD/HP groups along with increases in H. pylori colonization; however, there was no significant difference between these two groups with respect to stomach weight and colonization. On histological grading, mononuclear cell infiltration was severer in the AD/HP group than in the ND/HP group. These data suggest that chronic gastric inflammation was aggravated by AN treatment in the mice with H. pylori-induced gastric lesions. Furthermore, as previously suggested, this animal model is useful to determine the effect of potential carcinogens on gastric lesions induced by H. pylori infection.

• Journal of Oral Medicine and Pain
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• v.42 no.3
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• pp.81-84
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• 2017

Oral submucous fibrosis (OSF) is a premalignant condition characterized by juxtaepithelial fibrosis of the oral cavity. The clinical manifestations include burning sensation to spicy food, blanched oral mucosa with palpable fibrous bands, trismus, depapillation of tongue, and dry mouth. As OSF is predominantly seen in people of the Indian subcontinent, cases of this disease have been rarely reported in South Korea. We present a case of OSF in a Sri Lankan man living in South Korea and emphasize the importance of enhancing knowledge of this disease while the number of immigrants is increasing.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.10
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• pp.4429-4434
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• 2015

Background: Public awareness/knowledge on oral and pharyngeal cancer (OPC), potentially malignant disorders (PMODs) and their risk factors is crucial for prevention and early detection of OPC and PMODs. Yet, there are no published data available on the awareness and knowledge of OPC and PMODs among people living in Far North Queensland, Australia. Materials and Methods: This study was conducted as a cross sectional survey. A self-administered questionnaire was designed and consisted of relevant questions to ascertain socio-demographic information, awareness and knowledge of OPC, PMODs and risk factors and questions on participant's exposure to risk factors and dietary history were also included. Survey was carried out at the Dental Clinic of the James Cook University School of Dentistry (JCU Dental), Cairns, Australia. Subjects above the age of 20 years (n=366) were randomly selected during the period from 31st July to 6th September 2013 and questionnaire was distributed to complete while they are waiting for treatment. Data analysis was carried out using SPSS version 21 and the chi -squared test was employed to compare groups. P<0.05 was considered statistically significant. Results: The study revealed that 52.3% of the respondents were aware of the existence of OPC but only 19.0% were aware of PMODs. Of those who were aware of oral cancer, 92% agreed or strongly agreed that smoking is a strong risk factor for OPC. Similarly a relatively high proportion of the respondents agreed or strongly agreed that tobacco chewing (84%), tobacco chewing with areca nut (68%), chewing areca nut alone (51%) and exposure to actinic radiation (71%) as risk factors. However, the results for alcohol intake, age, and HPV infection were found to be relatively poor with proportions 33%, 34%, and 23% respectively. Conclusions: This study revealed an alarming lack of awareness and knowledge of OPC and PMODs.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.23
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• pp.10129-10135
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• 2015

Background: Tobacco is a leading preventable cause of deaths worldwide; the situation is particularly serious in the developing countries. Tobacco use amongst the children and adolescents is already a pandemic and they are vulnerable targets of tobacco industry. This is also the case in India. Objectives: 1) Document and monitor the prevalence of tobacco use including smoked, smokeless and other forms of tobacco; 2) Understand student knowledge and attitudes related to tobacco use and its health impact; 3) Assess the impact of tobacco on the oral health status of school-going children in India. Materials and Methods: The sample was 1,500 school children of the age group 12-15 years age. A pretested, close ended questionnaire was administered in the form of extensive face to face interview to understand student knowledge, attitudes and behavior related to tobacco use and its health impact and to assess the prevalence of tobacco use including smoked, smokeless and other forms of tobacco. Oral health status was assessed using the Community Periodontal Index (CPI). Frequency distribution, Chi-square tests and Odd's ratio was calculated. Results: Prevalence of tobacco usage amongst the prevalence was 20.4%: 9.2% reported smoking, 15.8% used tobacco in the chewable form and 25.3% children were involved in consuming betel nut/areca nuts. The OR (Odd's ratio) for calculus formation was highest for guthka chewers (OR=14.322), paan masala chewers had the highest odds of developing bleeding on probing when compared to the others. Conclusions: There is an urgent need to launch school-based tobacco prevention programs for community awareness of children and the public, as preventing the initiation of a habit is far easier than stopping it.